Provider Demographics
NPI:1699669648
Name:GORDON, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41499 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:CO
Mailing Address - Zip Code:80754-9312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41499 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:CO
Practice Address - Zip Code:80754-9312
Practice Address - Country:US
Practice Address - Phone:970-580-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program